Impact Of Circadian Rhythm On Outcome After Coronary Artery Bypass Graft Surgery

Objective:To explore the relationship between biological rhythms and elective off-pump coronary artery bypass graft(OPCABG)postoperative complications in patients with coronary heart disease,determining the effect of operation timing for short-term postoperative complication.To provide a reference for planning individual surgical project,improving treatment and care quality of CABG patients,reducing the incidence of postoperative complications and lead to reasonable distribution of medical resources.Methods:According to the inclusion criteria,retrospective analysis was performed on 1047 cases who only receive CABG for coronary heart disease(CHD),had been diagnosed by coronary angiography(CAG),in the First Affiliated Hospital of Nanjing Medical University form Jan.2006 to Dec.2015.Collecting perioperative clinical date,for the exclusion criteria,1014 cases were included in the analysis.All patients were divided into morning(6:00 to 12:00)vs aftemoon(after 12:00)group,working(Monday to Thursday)vs weekend(Friday to Sunday)group,winter and spring(November to April)vs summer and autumn(May to October)group for the operation timing.Finding the different of complications in each group through statistical analysis.Univariate regression analyses were performed to identified susceptible variables according to the occurrence of postoperative complications.Susceptible variables and variables associated with outcome after CABG in the literature were analyzed to calculate predicted probabilities of complications using a multivariate logistic regression model.Results:1.Morning group is older in age,higher in BMI,longer in duration of surgery,mechanical ventilation and ICU than afternoon group,but the mortality and morbidity have no significant difference between the two groups;2.Working group and weekend group have no difference in pre and intra operative,but the postoperative mortality(4.6%vs 1.8%,P=0.03)and morbidity(18.8%vs 9.9%,P=0.0004)is significant higher in weekend group;3.Compared with summer and autumn group,winter and spring group have no difference at preoperative clinical date,but at case duration,length of stay is longer,postoperative mortality(3.3%vs 1.4%,P=0.01)and morbidity(14.6%vs 8.5%,P=0.003)is significant higher than former;4.On multivariate analysis,EuroscoreⅡ(OR 1.28,95%CI 1.06-1.54,P=0.01),day of surgery(OR 2.13,95%CI 1.38-3.29,P<0.00),season of surgery(OR 1.83,95%CI 1.23-2.73,P<0.00)were associated with an increased risk of postoperative complication.Conclusion:For selective OPCABG patients,operation timing(morning or afternoon)has no effect on postoperative mortality and morbidity,even though the preoperative condition has differences.Postoperative mortality and morbidity are significant higher when operation was performed on Friday to Sunday when compared with working days;and postoperative mortality and morbidity was also increase in winter and spring when compared with summer or autumn.Operation on weekends or winter and spring can increase the risk of postoperative complication when Preoperative risk assessment with no significant difference.